Lancet On Iraqi Mortality

Monday, November 24, 2008

Counterfactual

I can't vouch for most of the analysis here (and is it tongue-in-cheek?), but it is an interesting take on the question of what mortality would have been in Iraq in a counterfactual world without the US-led invasion and occupation.

The sanctions regime, which began in 1990, destroyed Iraq’s economy (reducing GDP by as much as three quarters) and impoverished millions of Iraqis. Particular attention was given at the time to its effect on children. The contemporary critics of the sanctions pointed out that before the sanctions began, the child mortality rate was about 50 per 1000; during the sanctions, on one accounting the rate soared to about 128 per 1000 (click on "basic indicators" here). More conservative estimates were in the range of a doubling of child mortality. Using the more conservative estimate, at one million births per year, this works out to an annual difference of 50,000 children surviving to the age of 5 (for various qualifications, see here). Today, the child mortality rate is below the pre-sanctions figure, and so every year in excess of 50,000 more Iraqi children survive than during the sanctions. The data are hotly contested but the trends are unmistakable and will continue to strengthen if security improves. Meanwhile, violent deaths of civilians, while still far too high, are declining; a very cautious estimate of 500-800 per month, based on the most recent reports on the Iraq Body Count website, is much lower than the avoided deaths of children compared to the sanctions regime. A conservative estimate is that more than 40,000 Iraqis survive per year today than during the sanctions regime, and probably most of them children. The tight correlation between GDP and child mortality across countries bolsters this conclusion.

Let’s suppose that the sanctions regime had continued for 10 years, from 2003 to 2013, and further that security flattens out—it doesn’t get worse, but it doesn’t get better. Under these assumptions, 400,000 Iraqi children would have died if the war had not occurred and the sanctions regime continued. Now, almost 100,000 Iraqis died during the war, and so one of the war’s benefits is that it saves the lives of 300,000 Iraqis (over 10 years).

I have always been suspicious of child mortality estimates during the sanctions period, and of old data in general. I just link to this piece to highlight the difficulties in honestly estimating "excess deaths." All of this also ignores the question of what Saddam's policies would have been had he stayed in power. If he would have been as "peaceful" in the future as he was in 2002, then excess deaths is one number. But, if he had become less peaceful (more in line with the previous decades of neighbor-invasion (Iran, Kuwait) and internal-slaughtering (Shia, Kurds), then excess deaths are much lower, even negative, as a result of the invasion.

But, as always, my main focus is on the Lancet surveys. They make an explicit comparison to mortality in 2002 to March 2003, so these discussions are largely irrelevant. (Hat tip Andrew Sullivan.)

Sunday, November 16, 2008

IBC Estimates

I am a big fan of IBC but, at the same time, it is important to remember that they are reliant on news reports. This can lead, obviously, to under-counting since not every death makes the news. But it can also lead to over-counting since the news is not always reliable.

Consider this AP article from November 15. (Thanks to a friend for the pointer.)

Counting the dead gets more complicated in Iraq

By KIM GAMEL – 1 day ago

BAGHDAD (AP) — This much is agreed — a double bombing in Baghdad struck a school bus and those responding to the first blast. But the difference in casualty figures was stark. Iraqi officials said 31 people died; the U.S. military put the death toll at five.

The conflicting reports from Monday's attack are emblematic of a spate of recent bombings that have raised fears of a resurgence in violence.

There have always been disagreements because accurately counting the dead in the chaos of Iraq's war has never been easy. Yet discrepancies appear to be widening as the political stakes grow.

U.S. officials privately say that some officials in the Shiite-dominated Interior and Health ministries could possibly have political or personal motives for inflating casualty numbers for bombings in mainly Shiite areas.

Iraqi officials insist their tallies are more accurate, saying the figures are based on death certificates issued by hospitals and the number of wounded who receive treatment.

The increase in attacks comes at a sensitive time for Iraq, with political tensions heating up ahead of provincial elections that are due to be held by Jan. 31 and are expected to shift some power to the disaffected Sunni minority.

Sunni and Shiite extremists also oppose negotiations that are under way over a proposed U.S.-Iraqi security pact that would extend the presence of American forces in the country beyond the end of the year.

U.S. officers acknowledge the difficulties in establishing accurate numbers but express confidence their figures come close thanks to an increased presence of American troops who have spread throughout the community to work with their Iraqi counterparts.

American soldiers race to the site of bombings, often with the Iraqi security forces that are responding to the attacks. Those troops interview witnesses as well as rescue crews to reach a consensus on casualties and the type of attack, the military said.

"We do have enough soldiers throughout the battle space that when there is an explosion, we hear it and basically we run to the sound of the gun," said Lt. Col. Steve Stover, a spokesman for U.S. forces in Baghdad.

If the U.S. military is unable to promptly reach the scene, it depends on casualty reports from American transition teams working with the Iraqi security forces that do.

It's a change from earlier in the war, when American troops focused on fighting insurgents and often declined to provide civilian casualty information.

Adel Muhsin, a top Health Ministry official, said the Americans generally aren't getting the full picture, pointing out that victims often die of their wounds at the hospital or on the way there.

"The U.S. figures are based on the preliminary reports. Usually, the first view is not completely dependable because the site is still chaotic," Muhsin said. "Preliminary and initial figures taken shortly after the explosion tend to be small."

John Pike, a military and security analyst who runs the respected Web site GlobalSecurity.org, said methodology and politics on both sides could be at play in the differing numbers.

He noted that followers of anti-U.S. Shiite cleric Muqtada al-Sadr, a rival of Prime Minister Nouri al-Maliki's government, wield influence in the Health and Interior ministries.

"I could easily imagine that the U.S. government would want to get a low number, which would suggest that peace is at hand, and that al-Sadr might want a high number to suggest that maybe al-Maliki is not doing such a good job after all," Pike said. "You could imagine both methodological and political explanations for the discrepancy."

The issue came to the fore this week when a series of bombings targeting Shiite areas over three consecutive days rattled the growing sense of confidence among Iraqis about security gains.

_ On Monday, the Interior Ministry said 27 people were killed in the bus attack. Police and hospital officials contacted by Associated Press staff put the death toll at 31, which would make it the deadliest blast in the capital in six weeks. The U.S. military, citing Iraqi army figures, said five were killed.

_ On Tuesday, Iraqi police and hospital officials said three people died when twin blasts hit a newspaper delivery truck and nearby vendors. The U.S. military said 18 people were wounded, including three Iraqi policemen and 15 civilians.

_ On Wednesday, Iraqi police and hospital officials said 23 people were killed in a series of bombings in mostly Shiite areas of the capital. The U.S. military said one civilian died and 46 were wounded in four separate attacks.

Iraq Body Count, an independent organization that tracks media reports as well as official figures, put the death tolls at 27 in Monday's attack, four on Tuesday and 28 on Wednesday.

So, IBC estimates 59 civilian deaths for these three attacks. The US military estimates 6 dead (assuming no deaths in the Tuesday attack). Who is right? I don't know. But the insistence by many that IBC represents a minimum estimate is suspect.

The are other similar examples. Consider these two strories (here and here) from Bob Owens. Both of these incidents are still included in the IBC database (here and here) even though Owens provides fairly compelling evidence that the incidents were fake.

Does that reflect poorly on IBC? No! They are doing what they have always promised to do: catalog reported civilian casualties. They do an amazing job, especially by showing everyone their raw data and including supporting details. It is not their fault that media reports are sometimes false. And, in these cases, the specific reports could be true. The evidence presented by Owens is powerful but not conclusive. And, to be fair to Owens, it is impossible for him to prove a negative, that these deaths did not occur.

Yet this means that those who insist that IBC must be a (dramatic) under-estimate should take more seriously the claim that not every reported death actually occurred. In at least these cases, there is reason to believe that the IBC count is too high.

About Me

I am an Institute Fellow at IQSS at Harvard. I organized a panel on mortality in Iraq for the August 2008 Joint Statistical Meetings in Denver, Colorado. Participants on the panel includes Safaa Amer of NORC, Michael Spagat of Royal Holloway College, University of London, Mohamed Ali of WHO and Olivier Degomme of WHO Collaborating Centre for Research on Disaster Epidemiology.